Prognostic influence of Korean public medical insurance system on breast cancer patients

Hwang, Kihwan; Ju, YeoJin; Kim, Young A; Kim, Jong-Jin; Oh, Sohee; Jung, Jiwoong; Chai, Young Jun; Choi, In Sil

doi:10.4174/astr.2019.96.2.58

Cited by 6 publications

(4 citation statements)

References 28 publications

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“…Additionally, some studies have also demonstrated that lower SES was associated with worse HCC-specific survival (30)(31)(32). Furthermore, previous studies examining the relationship between insurance and survival in other countries also have shown that patients with a good insurance status have better survival than those with poor insurance status, not only among HCC patients, but also among many other cancers (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Several mechanisms may contribute to the observed disparities in HCC survival between UEBMI and URRBMI.…”

Section: Discussionmentioning

confidence: 99%

“…A previous study reported that patients with no insurance were more likely to be diagnosed at an advanced stage for all cancers when compared to those with private insurance (7). Furthermore, many studies have claimed that insurance status might be an important prognostic factor because of its impact on access to health care (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Two studies have reported that Medicare or commercial insurance, compared with Medicaid or no insurance, were associated with improved HCC survival in the United States (15,16).…”

Section: Introductionmentioning

confidence: 99%

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Disparities in Hepatocellular Carcinoma Survival by Insurance Status: A Population-Based Study in China

Liu

Wang

2021

Front. Public Health

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Objective: Health disparities related to basic medical insurance in China have not been sufficiently examined, particularly among patients with hepatocellular carcinoma (HCC). This study aims to investigate the disparities in HCC survival by insurance status in Tianjin, China.Methods: This retrospective analysis used data from the Tianjin Basic Medical Insurance claims database, which consists of enrollees covered by Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Resident Basic Medical Insurance (URRBMI). Adult patients newly diagnosed with HCC between 2011 and 2016 were identified and followed until death from any cause, withdrawal from UEBMI or URRBMI, or the latest data in the dataset (censoring as of December 31st 2017), whichever occurred first. Patients' overall survival during the follow-up was assessed using Kaplan-Meier and extrapolated by six parametric models. The hazard ratio (HR) and 95% confidence intervals (CI) were calculated with the adjusted Cox proportional hazards model including age at diagnosis, sex, baseline comorbidities and complications, baseline healthcare resources utilization and medical costs, tumor metastasis at diagnosis, the initial treatment after diagnosis and antiviral therapy during the follow-up.Results: Two thousand sixty eight patients covered by UEBMI (N = 1,468) and URRBMI (N = 570) were included (mean age: 60.6 vs. 60.9, p = 0.667; female: 31.8 vs. 27.7%, p = 0.074). The median survival time for patients within the UEBMI and URRBMI were 37.8 and 12.2 months, and the 1-, 3-, 5-, 10-year overall survival rates were 63.8, 50.2, 51.0, 33.4, and 44.4, 22.8, 31.5, 13.1%, respectively. Compared with UEBMI, patients covered by URRBMI had 72% (HR: 1.72; 95% CI: 1.47–2.00) higher risk of death after adjustments for measured confounders above. The survival difference was still statistically significant (HR: 1.49; 95% CI: 1.21–1.83) in sensitivity analysis based on propensity score matching.Conclusions: This study reveals that HCC patients covered by URRBMI may have worse survival than patients covered by UEBMI. Further efforts are warranted to understand healthcare disparities for patients covered by different basic medical insurance in China.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Disparities in Hepatocellular Carcinoma Survival by Insurance Status: A Population-Based Study in China

Liu

Wang

2021

Front. Public Health

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“…Medical Aid is independently operated by the Korean government from the NHI. Medical Aid is a social safety net to secure the minimum livelihood of low-income households [ 14 ]. To qualify for Medical Aid, beneficiaries must be from a low-income household where the head of the household is unable to work.…”

Section: Methodsmentioning

confidence: 99%

Long-Term Effect of Income Level on Mortality after Stroke: A Nationwide Cohort Study in South Korea

Jeong

Cho

Kong

2020

IJERPH

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We investigated whether income level has long-term effects on mortality rate in stroke patients and whether this varies with time after the first stroke event, using the National Health Insurance Service National Sample Cohort data from 2002 to 2015 in South Korea. The study population was new-onset stroke patients ≥18 years of age. Patients were categorized into Category (1) insured employees and Category (2) insured self-employed/Medical Aid beneficiaries. Each category was divided into three and four income level groups, retrospectively. The study population comprised of 11,668 patients. Among the Category 1 patients (n = 7720), the low-income group’s post-stroke mortality was 1.15-fold higher than the high-income group. Among the Category 2 patients (n = 3948), the lower income groups had higher post-stroke mortality than the high-income group (middle-income, aOR (adjusted odds ratio) 1.29; low-income, aOR 1.70; Medical Aid beneficiaries, aOR 2.19). In this category, the lower income groups’ post-stroke mortality risks compared to the high-income group were highest at 13–36 months after the first stroke event(middle-income, aOR 1.52; low-income, aOR 2.31; Medical Aid beneficiaries, aOR 2.53). Medical Aid beneficiaries had a significantly higher post-stroke mortality risk than the high-income group at all time points.

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“…Medical Aid is a public assistance program aimed at securing a minimum livelihood for low-income households by providing medical services nearly free [ 15 ]. Medical Aid beneficiaries do not pay health insurance premiums.…”

Section: Methodsmentioning

confidence: 99%

Effect of income level on stroke incidence and the mediated effect of simultaneous diagnosis of metabolic syndrome diseases; a nationwide cohort study in South Korea

Jeong

Cho

Kong

2022

Diabetol Metab Syndr

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Background This study aimed to determine whether a simultaneous diagnosis of main components of metabolic syndrome (MetS) (hypertension, diabetes mellitus, and dyslipidemia) plays a mediator between income level and stroke. Methods We used the National Health Insurance Service National Sample Cohort database from 2006 to 2015. The mediator variables were the number of main MetS components diagnosed simultaneously (two or more/three or more). We used a weighting approach method of causal mediation analysis to apply counterfactual frameworks to the Cox proportional hazards regression model. Results A total of 213,526 people were included with 1,690,665.3 person-years of followed up. Compared with the high-income group, the risk of being diagnosed with two or more components of MetS significantly increased in all other income groups [middle-income OR 1.05 (95% CI 1.02–1.08); low-income OR 1.09 (95% CI 1.05–1.12); Medical Aid beneficiaries OR 1.39 (95% CI 1.32–1.47)]. A lower level of income was significantly associated with a higher risk of stroke compared with the high-income group [middle-income HR 1.15 (95% CI 1.07–1.25); low-income HR 1.19 (95% CI 1.10–1.29); Medical Aid beneficiaries HR 1.63 (95% CI 1.48–1.80)]. In the Medical Aid beneficiaries, simultaneous diagnosis of the main metabolic components acted as a significant mediator between income levels and stroke incidence, with 26.6% mediated when diagnosed with two or more diseases and 21.1% when diagnosed with all three. Conclusions Co-diagnosis of MetS components played a significant mediator role between income level and stroke incidence.

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Prognostic influence of Korean public medical insurance system on breast cancer patients

Cited by 6 publications

References 28 publications

Disparities in Hepatocellular Carcinoma Survival by Insurance Status: A Population-Based Study in China

Disparities in Hepatocellular Carcinoma Survival by Insurance Status: A Population-Based Study in China

Long-Term Effect of Income Level on Mortality after Stroke: A Nationwide Cohort Study in South Korea

Effect of income level on stroke incidence and the mediated effect of simultaneous diagnosis of metabolic syndrome diseases; a nationwide cohort study in South Korea

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